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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
; FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 43709 (R71 / 6-09)
,� l Presaibed by �epartmerd of Laml GovemmeN Fu�ance
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fNSTRUCTIONS: _
To be filed in person or by mail with the CounryAUdifo� or Counry Recorder of the county where fhe property is focated.
Fi7irg Dates: 7J Real Pmperfy: Must file during the year /or which the deduction is sough[.
2) Mo6de /Manufactured Homes rrot assessed as Real Property Must file dunng the twelve (72) months
6etora Ma�ch 37 07 each year the deduclion is sought.
See �verse side !or addiWnal inst/uctions arM qualifications.
Aod'innt (owner or oonfrdfY 6uve�- see ie5f�idions m reverse si7e1 _ . f� ..
papeny as of
K M. W�18� 6 �16 / i1Qf CXdfS 5�Id2 0( IIIiG
tt nane m 2mN a Etlfrlent than Wt o(
u
uidirate beb�r.
Mark
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ca,ory'Aem.ae,
GIBSON COUNTY AUDI70R
RecoN rwm6er Page nurtibef
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5s unpaM as U Martgage / Contract inEeMedness unpaiG as of Is Ne app6rant Ne wk
Eate ot appliration legal o equitade ameR
� Yes ❑ No
If owneE wiM someorie oNer tlian spouse.'u�dirate wiTh wlwm
�ihe WoPert1' in Question: MnuaM 0.�esud
eal Pioperty ❑ MnuaRjPSSessed
rv3f118O1 2EIXWIIQ'dll Pl
�p �y' I ('p� .�Z✓L�
ress oi mongagee «cannacc seuer (numbri and saeeG crty, srare. arm Zra code)
Nama of assignee w alher owner or hdder of mortgage
ACCress ot asse,piee (numDeiand svee4 �Y, state, and ZIP cotle)
Oces applinnt am p�operty in any other If yes, whal county?
munty m InOiana? ,�{�
❑ Yes L]t'No
forcurtentyeaR
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